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目的探究大范围幕下结构扩散加权成像的平均扩散系数(MD)直方图鉴别帕金森病的有效性。材料与方法本研究经地方机构审查委员会批准,免除知情同意书。10例帕金森病(PD)病人、9例帕金森型多系统萎缩病人(MSA-P)、7例小脑型MSA(MSA-C)病人、17例进行性核上麻痹-理查森综合征病人(PSP-RS)以及10例健康受试者纳入本研究。绘制全部幕下结构所有像素的MD值直方图及脑干、小脑蚓部、小脑半球的MD值直方图。采用Kruskal-Wallis检验分析组间MD值差异,随后应用Mann-Whitney U检验进行配对比较。应用Bonferoni法对所有配对比较的P值进行校正。结果与其他组相比,MSA-P组与MSA-C组的脑干及小脑MD值的中位数更高(P<0.01),该发现与这些疾病的后颅窝神经退行性损伤相一致。小脑半球MD值的中位数可用于区分MSA-C、MSA-P病人与PD及PSP-RS病人(P<0.01;敏感度、特异度和阳性预测值均为100%)。此外,PSP-RS病人小脑蚓部的MD值显著高于健康受试者(P<0.05)与PD病人(P<0.001)。结论这些发现证实了扩散成像对帕金森综合征鉴别诊断的临床有效性,提示幕下结构,尤其是全小脑半球的最低限度操作者依赖直方图分析可用于鉴别MAS-P、MAS-C病人与PSP-RS、PD病人。
Objective To explore the validity of the diffusion coefficient (MD) histogram for diffusive weighted imaging of the supratentorial structures in the identification of Parkinson’s disease. Materials and Methods The study was approved by the local institutional review board and exempted from informed consent. 10 patients with Parkinson’s disease (PD), 9 patients with Parkinson’s multiple system atrophy (MSA-P), 7 patients with cerebellar MSA (MSA-C), 17 patients with progressive supranuclear palsy- Richardson syndrome PSP-RS) and 10 healthy subjects were included in this study. Draw the histogram of MD values for all pixels of the sub-screen structure and the histogram of the MD values of the brainstem, cerebellar vermis and cerebellar hemispheres. Kruskal-Wallis test was used to analyze differences in MD values between groups, followed by a pairwise comparison using the Mann-Whitney U test. Bonferoni’s method was used to correct all paired comparison P values. Results Compared with other groups, MSA-P group and MSA-C group had a higher median MD of brain stem and cerebellum (P <0.01), which was consistent with the posterior fossa neurodegeneration in these diseases . The median MD of cerebellar hemispheres was used to distinguish MSA-C, MSA-P patients from PD and PSP-RS patients (P <0.01; both sensitivity, specificity, and positive predictive value were 100%). In addition, the MD of cerebellar vermis in PSP-RS patients was significantly higher than that in healthy subjects (P <0.05) and PD patients (P <0.001). Conclusions These findings confirm the clinical validity of diffusion imaging in the differential diagnosis of Parkinson’s disease, suggesting that subsurface structures, and in particular the minimal operator of the whole cerebellar hemisphere, rely on histogram analysis to identify MAS-P, MAS-C patients with PSP -RS, PD patients.